AB1058 GENDER DIFFERENCES IN SPONDYLOARTHRITIS: FOCUS OF THE CLINICAL BURDEN OF DISEASE IN FEMALE PATIENTS
Authors: F. Fattorini, C. Cigolini, C. Cardelli, G. Marchetti, A. Delle Sedie, L. Carli, M. Mosca
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spondyloarthritis (SpA) are a group of systemic autoimmune diseases, mainly affecting musculoskeletal system, with typical axial or peripheral forms. Recent data from the literature show significant differences in SpA subsets, levels of disease activity, drug efficacy and quality of life between male and female sex. <sup>[1, 2]</sup> It is well known how disease activity and comorbidities could compromise physical function and quality of life of SpA patients. <h3>Objectives</h3> To describe the clinical characteristics of women with SpA in our single-centre cohort compared to men, in relation to clinical characteristics, disease activity, therapy and comorbidities. <h3>Methods</h3> Adult patients with a diagnosis of Psoriatic Arthritis (PsA) and Axial Spondyloarthritis (AxSpA) according to CASPAR (ClASsification criteria for Psoriatic Arthritis) and to Assessment of SpondyloArthritis international Society (ASAS) criteria, regularly followed at the SpA clinic of our unit, were consecutively enrolled from April to December 2022. Their epidemiologic, clinic and clinimetric data were collected. Intergroups comparisons were assessed by using Chi-square, t-test and ANOVA. P values &lt;0.05 were considered significant. <h3>Results</h3> A total of 200 patients were enrolled, 115 male (57.5%) and 85 female (42.5%) with comparable mean age values (M 56.13±14.48 years, F 56.84±12.22 years; p=0.508) and with a significantly shorter disease duration in women (12.9±10.3 years vs 17.05±12.08 years; p&lt;0.001). No differences in the distribution of PsA or AxSpA based on gender were observed. Six patients had a diagnosis of enteropathic SpA; all of them were women. Taking into account the clinimetric evaluations, female patients show higher values of both Disease Activity Index for Psoriatic Arthrititis DAPSA (15.63 vs 9.40; p=0.003), Leeds Enthesitis Index (LEI) (0.46 vs 0.16; p=0.02) and Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index (0.7 vs 0.4; p=0.05). The total number of drugs [both Biological disease modifying anti-rheumatic drugs (bDMARDs) and conventional synthetic DMARDs)] taken for disease control was 4.47±2.45 for women and 3.79±2.07 for men (p=0.012); no differences were observed between the 2 groups for any specific drug. Among the comorbidities, none of them was more prevalent in men, while osteoporosis (OP) (p=0,006), mood disorders (0,009), fibromyalgia (FM) (p&lt;0,000015), osteoarthritis (OA) (0,007) and thyroid disease (p&lt;0,000015) were significantly more frequent in women. <h3>Conclusion</h3> Women of our cohort show a significantly higher risk of developing an inflammatory bowel disease than men. Female patients have also higher levels of peripheral disease activity, both on joints and enthesis; moreover, they show a significantly lower persistence in drug therapy. Besides, they have a more complex disease, suffering more frequently of OP, OA, FM and thyroid diseases than men. Finally, it is very interesting to note how women tend to develop a much more complex disease, even with a significantly shorter disease duration than male patients. These data confirm how rheumatologists should focus on the assessment of women with SpA, aiming at promoting a closer monitoring of gastrointestinal symptoms, peripheral arthritis and enthesitis and at preventing the development of comorbid conditions, thus optimizing also their quality of life and physical functioning. <h3>References</h3> [1]Rusman T, van Bentum RE, van der Horst-Bruinsma IE. Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford). 2020 Oct 1;59(Suppl4):iv38-iv46. doi: 10.1093/rheumatology/keaa543. PMID: 33053194; PMCID: PMC7566372. [2]Duruöz MT, Gezer HH, Nas K, Kiliç E, Sargin B, Kasman SA et al, Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study. Joint Bone Spine. 2021 Jul;88(4):105177. doi: 10.1016/j.jbspin.2021.105177. Epub 2021 Mar 23. PMID: 33771757. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.